Saving Lives

DR ABCDE

  • Danger - is it safe to approach, wash hands, gloves etc, C-spine immobilisation if necessary

  • Response - does pt respond? if so airway is clear and at least V on AVPU scale

  • Airway - is it clear? head tilt, chin lift and suction if necessary, airway adjuncts

  • Breathing - if doubt breathing break to BLS else look, feel, listen, measure, treat, reassess, symmetrical chest expansion, RR, cyanosis, trachea, PN, BS, SpO2, ABG, Oxygen + airway adjuncts

  • Circulation - if doubt pulse break to BLS, if pulse else look, feel, listen, measure, treat, reassess, pale/pink, JVP, AO, warm/cold, central cap refill, pulse, BP, ECG, IV access, fluids, if pulse fast or slow (with pulse, break to tachy/brady alogrithms)

  • Disability - AVPU, BM, moving all limbs

  • Everything else - expose patient fully, look at drug chart, look at notes

Special Cases

Extra stuff may be added in to DR ABCDE for special cases e.g 10ml of 10% calcium gluconate, 10U actrapid + 50ml of 50% dextrose over 15-30min, salbutamol, dialysis, Ca resonium for hyperkalaemia, 20mmol/hour K+ for hypokalemia, O SHIT for Asthma, antedotes for poisons - see toxbase, naloxone 400mcg IV, Adrenaline 0.5mg IM 1/1000, hydrocortisone IM/IV 200mg, chlorphenamine IM/IV 10mg, for anaphylaxis , lorazepam 4mg IV over 2min, can repeat til 20mg given or pt stops breathing (flumazenil 200mcg, repeat 100mcg/min), anaethetist phenytoin etc.

Tachy/Brady

  • Fast

    • Fast with pulse unstable (reduced conscious level, chest pain, systolic BP < 90, HF), synchronised DC shock (with sedation or GA) up to 3 attempts then amiodarone 300mg IV over 10-20min and repeat shock, then amiodarone 900mg over 24h

    • Fast with pulse and stable and narrow complex regular - vagal manouvers, adenosine 6, 12, 12mg

    • Fast with pulse and stable and narrow complex irregular - B-blocker or digoxin, if onset $>$48h amiodarone 300mg over 20-60min then 900mg over 24h

    • Fast with pulse and stable and broad complex regular - Amiodarone 300mg over 20-60min then 900mg over 24h

    • Fast with pulse and stabel and broardcomplex irregular - Expert help

  • Slow

    • Slow with pulse unstable (systolic BP < 90, HR < 40/min, Ventricular arrythmias, HF), Atropine 500mcg IV, repeat to 3mg, pacing

    • Slow with pulse stable and risk of asystole (recent asytole, mobitz TII AV block, CHB, ventricular pause > 3s), Atropine 500mcg IV, repeat to 3mg, pacing

    • Slow with pulse stable and no risk of asystole, observe

BLS

  • Airway - is it clear? suction if necessary, airway adjuncts

  • Breathing & Circulation - look/listen/feel for breath sounds and carotid pulse for up to 10 sec - call for help + put out crash call 2222 if no signs of life and...

  • Give compressions and breaths in ratio of 30:2, compression depth 4-5cm rate 100/min, breaths 10/min until help arrives, if in hospital put cardiac monitor on and break to ALS

ALS

  • Rhythm assessment, stop compressions and look, if organized rhythm then 3 point pulse check

  • Shockable rhythm (VF/VT), charge, shock, 2 min cpr, check rhythm, DR ABCDE continues in back ground, consider reversible causes - 4Hs and 4Ts, 1mg 1/10,000 adrenaline before 3rd shock, 300mg amiodarone before 4th.

  • Non-shockable rhythm (PEA, asystole), adrenaline 1mg 1/10,000 and atropine 3mg (if less than 75bpm), 2 min cpr, check rhythm, DR ABCDE continues in back ground, consider reversible causes - 4Hs and 4Ts

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